Diseases Of The Nose Throat And Ear

CHAPTER 22
CHRONIC PHARYNGITIS

This is a most common condition and follows repeated attacks of acute
pharyngitis, over-indulgence in smoking, the use of raw spirits or an addiction
to highly seasoned foods. It may be caused by excessive or faulty use of the
voice, dental sepsis or prolonged exposure to dusty atmospheres. Chronic
infection of the nose or sinuses may predispose to it. Exacerbations tend to
occur after a period of increased work or worry.

For clinical purposes it may be discussed under three headings: (i) simple
catarrhal pharyngitis; (ii) hypertrophic pharyngitis (granular pharyngitis);
(iii) atrophic pharyngitis.

SIMPLE CATARRHAL PHARYNGITIS

This is the most common variety and is due to over-smoking, exposure to dust
or errors of diet. There is some oedema and congestion of the uvula, the soft
palate and the posterior pharyngeal wall on the surface of which dilated veins
may be seen. It produces a feeling of thickness in the throat and a frequent
desire to clear the throat. Treatment consists in avoidance of the cause—
correction of the diet, abstinence from alcohol and tobacco—or a drastic
reduction of consumption—and avoidance of dusty atmospheres. Locally an
astringent paint, such as Mandl's paint, or an astringent gargle, such as
hydrogen peroxide or ferric chloride, may be used.

HYPERTROPHIC PHARYNGITIS

This form is met with in those who have to use their voices professionally,
usually those who have not had training in voice production. The symptoms
are exaggerated when the patient is tense, overworked or worried. There is a
constant desire to clear the throat, and a feeling as if a foreign body were
present, but the chief complaint is that the voice soon becomes tired and its
carrying power is diminished. Most cases exhibit great irritability of the throat
and the mere opening of the mouth may induce the patient to gag and retch.
Small nodules of lymphoid tissue are seen scattered over the posterior
pharyngeal wall—hence the term granular pharyngitis. A thick vertical band
of lymphoid tissue may be seen on the lateral walls of the pharynx behind the
posterior pillars of the fauces.

TREATMENT. Treatment is by no means easy owing to the difficulty in
determining how far the symptoms are due to the objective changes seen in the
pharynx. A search should be made for any underlying factor in the teeth,
tonsils, sinuses or larynx. In a number of cases faulty voice production may be
the chief cause. Pitching the voice too high or incorrect breathing are common

107